| Background:Autologous bone has the advantages of good bone induction,bone conduction,histo-compatibility and bone regeneration,without immune rejection.For a long time,autologous iliac bone graft is considered to be the gold standard of bone material required for spinal fusion surgery and fracture fixation.With the continuous development of science and technology,decalcified bone matrix,xenogeneic bone or allogeneic bone,tissue engineering bone and other bone graft substitutes were widely used in clinical use.But until now,for osteogenesis,no studies have shown thats bone graft alternatives is better than autologous iliac graft.Iliac bone has been the most frequently used site by the clinical orthopedic surgeon.Although the biomechanical properties of bone obtained is poor,but iliac bone is rich in cancellous bone,can promote fracture healing and create a favorable condition for the treatment of fracture delayed healing and nonunion,and is commonly used materials.Iliac crest' location is superficial,no significant nerve and blood vessels around.Regardless of the anterior or posterior iliac can provide a wealth of bone volume.These advantages have been used by orthopedic surgeons.The iliac bone is divided into the anterior superior iliac spine and the posterior superior iliac spine,the anterior iliac bone could obtain 5 ~ 7 2cm3 bone mass,the posterior iliac bone can get 25 ~ 88cm3 bone mass.Iliac bone graft surgery seems simple,but when encountered iliac and surrounding tissue anatomical variation and surgery is not standardized or unskilled surgical operation,which may lead to postoperative wound dehiscence,local hematoma,infection,peripheral nerve injury,donor site long-term pain(? 6 months),iliac fractures,abdominal hernia,local skin depression and other complications increased.Some serious complications may have a serious impact on the patient's work and life.Clinically,although the iliac bone is the gold standard for bone grafting,some scholars believe that a small surgery,fewer complications,but studies suggest that if the surgeon did not pay attention to anatomy and surgical techniques,which may lead to adverse consequences.The reason for the complications of iliac bone removal is different,but some scholars have reported that if the ilium bone graft surgery is done carefully and the wound is properely managed,most of the complications could be avoided.Objectives:In order to find a way to reduce or avoid complication after iliac bone graft surgery,this study used polymethyl methacrylate cement filling to reconstruct bone defect in the posterior iliac crest and achieved satisfactory result.From the anatomical characteristics of the iliac bone and its surrounding tissue,these factors lead complication occurrence after iliac bone graft,the surgical instruments,the methods of bone graft and the length of incision,site to bone defect reconstruction and new type of bone graft replacement and other aspects of analysis and summary of the iliac bone surgery to find more ways,different scholars reported that the incidence of various complications after surgery are not the same.Methods:Our hospital from January 2010 to January 2015,in line with the inclusion of 82 cases of the iliac approach through the autologous iliac bone in patients with retrospective analysis,of which 43 cases of posterior iliac bone graft repaired with PMMA filling((35.37 ± 2.17)years old.The body weight was 46 ~ 80 Kg,the average was(65.56 ± 1.28)Kg.The age was 46 ~ 80 Kg,the average was(65.56 ± 1.28)Kg.And the remaining 39 patients the bone graft site was managed with bone wax.The patients was(41.33 ± 1.91)years old.The body weight was 48 ~ 82 Kg,the average was(P <0.05),and the average body weight was 48 ~ 82 Kg.(64.82 ± 1.21)Kg.The time of operation,bone volume,intraoperative blood loss,postoperative 24 h drainage,postoperative extubation total drainage,postoperative extubation time and postoperative 1 week,2 weeks and 2 months,December Visual analogue scale(VAS).Observation of postoperative wound dehiscence,local hematoma,infection,peripheral nerve injury,bone long-term pain(? 6 months),iliac fractures,abdominal hernia,bone depression and other complications Rate.1 year after the evaluation of patients with bone appearance and satisfaction with the appearance of waist belt comfort.Results:Both groups were well followed up for 1 year.(65.36 ± 1.28)Kg.The average age of the patients was(41.33 ± 1.91)years,and the average weight was(64.82 ± 1.21)Kg.There was no significant difference in the general data of PMMA group and bone wax group(P> 0.05).There was no significant difference between the two groups.The operative time was(27.91 ± 0.51)min and the bone mass was(36.09 ± 1.76)ml.The operation time was 27.90 ± 0.49 min and 35.39 ± 1.78 ml.There was no significant difference between the two groups in operation time and bone mass(P> 0.05).The intra-operative blood loss of PMMA group was(137.91 ± 5.19),the postoperative 24 h drainage was(12.60 ± 0.78),The total extubation time was(60.86 ± 1.92),the postoperative extubation time was(4.19 ± 0.16),The VAS scores were(2.67 ± 0.14),(1.58 ± 0.12),1 week,2 weeks,2 months and 1 year respectively,(0.37 ± 0.09)and(0.02 ± 0.02).The intraoperative blood loss was(209.23 ± 6.05),(23.85 ± 0.86),the total drainage after extubation was(140.92 ± 3.15),The postoperative extubation time was(8.15 ± 0.34).The VAS scores of 1 week,2 weeks,2 months and 1 year were(5.13 ± 0.18),(3.56 ± 0.19),(1.36 ± 0.10)and(0.21 ± 0.07).Two groups on(P <0.05).The PMMA group was superior to the bone wax group.The difference between the two groups was statistically significant(P <0.05).In the two groups,the appearance satisfaction rate(97.67% in PMMA group and 71.79% in bone wax group)and the comfort rate(97.67% in PMMA group and 69.23% i n bone wax group)were compared with those in PMMA group Were superior to the group of bone wax.The post-operative complications,PMMA group: 1 case of infection,1 case of long-term chronic bone pain(? 6 months).Bone wax group: bone local hematoma in 4 cases,4 cases of infection Nerve injury in 1 case,postoperative bone area long-term chronic pain in 8 cases,bone area depression in 5 cases.There were no cases of wound rupture,iliac fractures and abdominal hernia.The total number of postoperative complications in PMMA group was significantly lower than that in bone wax group(P <0.05).Conclusion:In this study,we found that polymethyl methacrylate bone cement reconstruct bone defect after bone grafting,and it plays a temporary spacer in the bone area,eliminate dead space and local support,and keep the appearance of the iliac shape intact.Reducing bone prominance at the end of the uplift,preventing local pain caused by belt squeezing,and reducing the complications of postoperative bone defects.In this study,the application of PMMA can induce pseudomembrane formation,and provide favorable osteogenic environment for bone reconstruction at the bone defect of bone cement under the condition of later reconstruction.PMMA has a good clinical value. |
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